Stercoral perforation is defined as a bowel perforation due to pressure necrosis from a faecal mass (faecaloma) 1. It is uncommon, but a life-threatening, complication of unresolved faecal impaction and can be a cause of acute abdomen secondary to faecal peritonitis.
It may represent 3.2% of all colonic perforations and 2.2% of randomly selected autopsy examinations 2. It generally occurs in older individuals 8.
The postulated pathogenesis is from a rise in intraluminal pressure which becomes greater than the capillary perfusion pressure within the bowel. This then results in focal ischaemia, necrosis, ulceration, and ultimately perforation 1-2.
It typically involves the recto-sigmoid colon on the antimesenteric side in ~90 % of cases 7.
Conditions causing chronic constipation:
- NSAID use: possible 7-8
- opioid/narcotic use 3
A universal component in a stercoral perforation is the formation of a faecaloma which is a localised hard, inspissated, or calcified faecal mass, usually of a diameter equal to or greater than the colonic lumen (due to the lowest blood supply and narrowest diameter).
There is evidence of extraluminal air +/- extruding faecal content. The site of perforation usually involves the antimesenteric border of the colon.
Treatment and prognosis
They can be life threatening with mortality rates ranging between 30-55% 8.
Stercoral perforations are almost always free and open, although to some extent plugged by a faecaloma, hence unlikely to resolve spontaneously with conservative management.
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- 8. Wu CH, Huang CC, Wang LJ et-al. Value of CT in the discrimination of fatal from non-fatal stercoral colitis. Korean J Radiol. 13 (3): 283-9. doi:10.3348/kjr.2012.13.3.283 - Free text at pubmed - Pubmed citation